NHS Gloucestershire CCG



Male breast reduction for gynaecomastia

|Commissioning decision |The CCG will provide funding for male breast reductions for gynaecomastia for patients who meet the |

| |criteria defined within this policy. Funding approval for eligible patients must be sought from the CCG |

| |via the Prior Approval process prior to treatment. |

Policy Statement:

|Surgery will be funded for gynaecomastia (growth of glandular tissue in male breast) where: |

|The reduction in breast tissue will be significant (i.e. 250g or more), with Simon Grade 3 or more (see evidence section) |

|OR |

|There is gross asymmetry |

| |

|In addition the patient must: |

|Be post-pubertal |

|AND |

|Be ≥ 18 years of age and the condition persistent for 2 years |

|AND |

|Have a BMI of ≤ 25 |

|AND |

|Have been investigated for possible endocrinological and/or drug related causes (see evidence section) |

Rationale:

|Most cases of gynaecomastia are idiopathic. It can also occur during puberty, when it tends to resolve as the post-pubertal fat |

|distribution is complete. It can also occur secondary to medication such as oestrogens, gonadotrophins, digoxin, spironolactone and |

|cimetidine, as well as anabolic steroids. |

| |

|Rarely it may be caused by an underlying endocrine abnormality or a drug related cause including the abuse of anabolic steroids. It is |

|important that male breast cancer is not mistaken for gynaecomastia and, if there is any doubt, an urgent consultation with an |

|appropriate specialist should be obtained. |

Plain English Summary:

|Gynaecomastia is a common condition that causes boy’s and men’s breasts to swell and become larger than normal. It is most common in |

|teenage boys and older men. Signs vary from a small amount of extra tissue around the nipples to more prominent breasts. It can affect |

|one or both breasts. Sometimes, the breast tissue can be tender or painful, but this isn’t always the case. |

|Gynaecomastia can be caused by an imbalance between the sex hormones testosterone and oestrogen. Oestrogen causes breast tissue to grow. |

|While all men produce some oestrogen, they usually have much higher levels of testosterone, which stops the oestrogen from causing breast|

|tissue to grow. If the balance of hormones in his body changes, this can cause a man’s breasts to grow. Sometimes, the cause of this |

|imbalance is unknown. The growth in breast tissue is not due to extra body fat from being overweight, so losing weight or doing more |

|exercise will not improve the condition. |

|In rare cases, gynaecomastia can be caused by: |

|side effects of medication, such as anti-ulcer drugs or medication for heart disease |

|illegal drugs, such as cannabis or anabolic steroids |

|drinking too much alcohol |

|a health abnormality, such as kidney failure or liver disease |

|Klinefelter’s syndrome, a rare genetic disorder |

|lumps or infection in the testicles |

| |

|There are two types of treatment for gynaecomastia: |

|surgery to remove the excess breast tissue |

|medication to adjust a hormone imbalance |

|Procedures such as breast reduction surgery are not usually available on the NHS unless there is a clear medical need. If your doctor |

|believes that you meet the criteria set out in this policy they can submit a Prior Approval application to the CCG in order to seek |

|funding approval for your surgery. The CCG will review your case and if we agree that the criteria have been met we will authorise |

|funding. |

Evidence base:

|Lanitis S, Starren E, Read J, Heymann T, Tekkis P, Hadjiminas DJ, Al Mufti R |

|Surgical management of Gynaecomastia: outcomes from our experience |

| |

|Gynaecomastia – Practice Clinical Updates |

| |

| |

|Diagnosis and assessment and drug related causes patient.co.uk/doctor/gynaecomastia |

| |

|Gynaecomastia classification and treatment options – evidence basis |

| |

| |

|Prostate Cancer - dealing with the side effects of treatment – enlarged breasts. |

| |

| |

|Simon et al. (Simon BE, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia Plast Reconstr Surg . 1973;51:48) |

|divided gynecomastia into four grades as follows: |

|• Grade 1: Small enlargement, no skin excess |

|• Grade 2a: Moderate enlargement, no skin excess |

|• Grade 2b: Moderate enlargement with extra skin |

|• Grade 3: Marked enlargement with extra skin |

Link to application form – Prior Approval Application Form

For further information please contact GLCCG.IFR@

|Date of publication |1st August 2015 (Minor amendment 7th February 2017) |

|Policy review date |November 2023 |

Consultation

|Consultee |Date |

|Planned Care Programme Board |31st March 2015 (virtual) |

|CCG Governing Body Development Session |4th June 2015 |

|GHNHSFT (via General Manager/Head of Contracts) |18/05/2015 – 29/05/2015 |

|GP Membership (via CCG Live/What’s New This Week) |06/05/2015 – 05/06/2015 |

| | |

|Has the consultation included patient representatives? |No |

Policy sign off

|Reviewing Body |Date of review |

|Effective Clinical Commissioning Policy Group |8th November 2016 |

|Integrated Governance and Quality Committee |18th June 2015 |

Version Control

|Version No |Type of Change |Date |Description of Change |

|1 | |1.8.15 | |

|2 |Date & link added |18.10.18 |Review date changed to Nov 2023. Link to Prostate |

| | | |Cancer (dealing with side effects of treatment) added|

| | | | |

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Policy Category:

CBA&PA

Who usually applies for funding?

GP/Consultant

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